Provider Demographics
NPI:1891783619
Name:JACKSONVILLE HEALTH CARE
Entity Type:Organization
Organization Name:JACKSONVILLE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-586-3616
Mailing Address - Street 1:305 BONITA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-5743
Mailing Address - Country:US
Mailing Address - Phone:903-586-3616
Mailing Address - Fax:903-586-1157
Practice Address - Street 1:305 BONITA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5743
Practice Address - Country:US
Practice Address - Phone:903-586-3616
Practice Address - Fax:903-586-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111535314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675011Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER